The London Breast Centre
Contents Introduction 4 One-Stop Breast Care Clinic 5 Common breast problems 6 Hereditary breast cancer 8 Breast cancer and cancer screening 9 Breast diagnostic tests 10 Breast reconstruction 12 Oncology services 13 Referral process 14 International patients 15 Contact details 16 2 3
Introduction The London Breast Centre at London Bridge Hospital provides rapid advice, diagnosis and treatment for anyone who may be concerned that they have a breast problem. Our Women s Health Services are recognised nationally and internationally for clinical expertise, fast assessment and customised care. We offer the very best facilities with extensive clinical back-up, at one of the UK s leading private hospitals. At The London Breast Centre, we work to ensure your appointments and treatment are arranged in a way that is convenient and accessible. Appointments are available in the late afternoon or early evening to avoid disruption to your day wherever possible. After an initial consultation with one of our dedicated Breast Centre Consultants, any necessary tests can be carried out quickly and efficiently during your visit and your preliminary results will be explained to you before you leave the Centre. The entire process of consultation, testing and delivery of results can be carried out in approximately two and a half hours. One-Stop Breast Clinic Our One-Stop Breast Clinic draws on the expertise of the country s leading breast units. Our team of surgeons, radiologists and pathologists are responsible for many of the latest advances in breast disease assessment and management. We offer diagnosis and treatment for: Benign breast conditions Breast cancer Family history risk assessment. Should further consultation be required, referral to a London Bridge Hospital Consultant Oncologist, Breast Plastic Surgeon or Clinical Geneticist can be arranged easily and quickly. 4 5
Your One-Stop Centre for help with common breast problems Mastalgia Breast pain is a common problem, but is hardly ever a sign of underlying breast cancer. The breast tissue is very sensitive, and it is therefore normal to experience changes in the breast, including pain. Sometimes the pain can reach a level when it may affect the patient s normal daily routine. The London Breast Centre offers advice and treatment for women suffering with breast pain, which can achieve significant improvements to relieve their discomfort. Breast cysts Breast cysts are probably the most common cause for developing a discreet lump in the breast. These cysts are best diagnosed by an ultrasound scan. It is unusual to develop any serious consequences from breast cysts. Nearly every woman will have breast cysts at some time in her life, therefore you should not consider breast cysts as having any significant malignant potential. Fibroadenoma A fibroadenoma is the most common cause of a lump in young women, usually those between the ages of 15-30. In contrast to a cyst, a fibroadenoma is a solid lump comprising swirls of fibrous tissue with occasional compressed breast ducts. Fibroadenomas are entirely painless, and probably arise due to hormonal changes in the breast. As a consequence, the lump may arise in an area of the breast where there is already more generalised hormonal breast pain and tenderness, giving the false impression that the lump is causing the pain. Nipple discharge A small amount of nipple discharge can be entirely normal, particularly for up to a year (or even more) after stopping breastfeeding. More copious nipple discharge, or the sudden onset of nipple discharge where this had not occurred before, should be investigated as directed by the Breast Consultant. Nipple discharge is usually examined with a mammogram, an ultrasound and by analysis of a small drop of fluid under a microscope. Sometimes it is necessary to carry out a small operation to remove one or more of the breast ducts for analysis, in order to be absolutely certain of the cause of the discharge. At The London Breast Centre, we provide breast duct micro-endoscopy. This specialist procedure involves placing a small camera through the natural opening in the nipple to view the inside of the milk ducts. This procedure may establish diagnosis without the need to resort to surgery. Breast infections Breast infections frequently occur during breastfeeding and may lead to a breast abscess. The problem is caused by bacteria infecting the milk that is within the breast. Prompt treatment with antibiotics at the outset often resolves the problem before it becomes very painful or before an abscess develops. Breast infections can reoccur and may become a long-term problem with the development of a constantly discharging opening at the edge of the nipple. This is termed a mammary fistula and will not heal without surgery. 6 7
Hereditary breast cancer A family history of breast cancer may be caused by gene abnormalities. Risk indicators may include: Two or more close relatives with breast or ovarian cancer under the age of fifty A close relative diagnosed with breast cancer before the age of forty A relative with breast cancer on both sides A male relative with breast cancer Any family member with a known susceptibility gene (BRCA1, BRCA2). If you think you may be at risk of hereditary breast cancer, The London Breast Centre can provide: Family History/Pedigree Analysis Personal risk assessment and surveillance guidelines Referral to a London Bridge Hospital Clinical Geneticist. Breast cancer and cancer screening Breast cancer is the most common type of cancer in the UK and will affect around 1 in 8 women at some time during their life, although it occurs more frequently in old age. Most women who develop breast cancer will be permanently cured following the correct treatment. Treatment is more effective if the breast cancer is caught in the early stages, this is the reason for undergoing breast screening (mammography). Mammography screening is the best proven means of early detection of breast cancer available today which, when followed by modern treatments provides the best chance of long-term survival. 8 9
Breast diagnostic tests Mammogram Mammograms are X-rays of the breast. Generally only carried out in women over the age of 40, mammograms are one of the most effective methods of investigating breast problems. A mammogram is performed by a female radiographer who has specialist training in this form of X-ray. Each breast in turn is carefully compressed between the two surfaces of the X-ray machine. The X-ray itself takes a few seconds and is repeated on the other side. Each breast is X-rayed from top to bottom and from side to side. Breast ultrasound Ultrasound is the same type of imaging that is carried out during pregnancy. It uses very high frequency sound waves, which are not audible and are completely safe. If you are under 40, your Consultant may suggest you have an ultrasound scan, as younger women tend to have denser breasts, which can reduce the ability of the mammogram to detect abnormalities. The ultrasound scan is performed by a Consultant Radiologist who specialises in breast radiology. MRI MRI is an additional imaging option for examining the breast. It combines the use of a very strong magnetic field and computer technology to provide extremely detailed images of internal and soft tissue structures of the breast. MRI requires a special dye to be injected in your arm, which helps to highlight abnormalities in breast tissue, before using specialist equipment to evaluate the size and number of lesions in the breast, as well as a more detailed examination of the other breast. It can also be a useful surveillance tool in women with very dense breast tissue and in women with a strong family history of breast cancer. Fine Needle Aspiration Cytology (FNAC) A fine needle biopsy works by obtaining single breast cells or small clusters of cells which can be easily examined by our Consultant Breast Pathologist. The analysis takes 20 to 30 minutes and the results are immediately available for you in the Centre. Core Needle Biopsy A core needle biopsy test uses a thicker needle than an FNAC. This enables the radiologist to take a small sliver of tissue. This test is performed when more clinical information is required. The tissue remains intact, as opposed to the dispersed cells taken in an FNAC; thus more information is given from this type of test and generally the full results from this test take approximately three days. Additionally, a unique service we offer at the Centre is Touch Imprint Cytology. This is a way of obtaining an immediate provisional result following core needle biopsy allowing us to give you as accurate a diagnosis as possible by the end of your appointment. 10 11
Breast reconstruction Breast reconstruction is surgery to make a new breast shape after mastectomy (removal of a breast). It is important to carefully discuss which type of reconstruction operation is most suitable for you, and the advantages and disadvantages of each. Who can have breast reconstruction? Breast reconstruction is possible for the majority of women who have had a mastectomy. Types of breast reconstruction There are several options in breast reconstruction, autologous reconstruction (using one s own tissue) and implant-only reconstruction. Principal types of breast reconstruction available at London Bridge Hospital, include: Implant Reconstruction Implant Reconstruction with Matrix Deep Inferior Epigastric Perforator Flap (DIEP Flap) Superior Gluteal Artery Perforator Flap (SGAP Flap) Transverse Myocutaneous Gracilis Flap or Transverse Upper Gracilis Flap (TMG or TUG Flap) Latissimus Dorsi Flap Profunda Artery Perforator Flap (PAP Flap) Oncology services Most breast problems are not the result of breast cancer; however, in the unlikely event that it is required, London Bridge Hospital has a comprehensive range of Oncology Services. London Bridge Hospital has full chemotherapy facilities including an Outpatient Clinic, a Day Unit and inpatient beds, as well as availability of investigative tools and state-of-the-art imaging facilities, including lowest-dose CT scanning. Our Consultants have extensive access to the latest breast cancer treatments and are responsible for many of the latest advances in breast cancer and cancer research. Studies of breast cancer management demonstrate that a close collaboration of different specialists, optimising their expertise, leads to the best outcomes. 12 13
Convenient referral process One referral is all it takes our dedicated GP Liaison Department liaises with your GP, Consultant, their secretary and yourself to provide a bespoke service. Once we have been contacted, we will take responsibility for booking appointments. The Department is able to organise timely and convenient appointments at The London Breast Centre. Available from 8.00am 6.00pm, Monday to Friday, our GP Liaison Team provides patients and GPs with a quick and smooth referral process. Self referral If you are concerned that you may have a breast problem, The London Breast Centre will also accept referrals from patients without seeing a GP first. Please contact the GP Liaison Team to arrange an appointment. Contact us For further information and appointments, please contact us on: Tel: +44 (0)20 7234 2009 Fax: +44 (0)20 7234 2019 Email: info.lbh@hcahealthcare.co.uk International patients The London Breast Centre at London Bridge Hospital offers an exceptional private healthcare service dedicated to caring for patients and visitors from all over the world. We are experienced in meeting the cultural needs of overseas patients, providing specialist menus, foreign language TV as well as translation services. Our specialist International Department also makes it easy for overseas patients to attend our clinics, including assisting and arranging transport between the hospital and their home/or airport, and locating suitable accommodation. Contact us For further information and appointments, please contact us on: Tel: +44 (0)20 7234 2459 Fax: +44 (0)20 7234 2258 Email: mohammed.hashem@hcahealthcare.co.uk 14 15
Contact Us For more information about The London Breast Centre, please visit our website at www.londonbreastcentre.co.uk or contact: Tel: 020 7234 2009 Fax: 020 7234 2019 Email: info.lbh@hcahealthcare.co.uk London Bridge Hospital 27 Tooley Street London SE1 2PR London Bridge Hospital is a trading name of HCA International Limited. Registered in England and Wales No. 03020522. Registered address: 242 Marylebone Road, London NW1 6JL